Association for Academic Surgery The use of ECMO for persistent pulmonary hypertension of the newborn: A decade of experience David A. Lazar, MD, a Darrell L. Cass, MD, a Oluyinka O. Olutoye, MB, ChB, PhD, a Stephen E. Welty, MD, b Caraciolo J. Fernandes, MD, b Peter T. Rycus, MPH, c and Timothy C. Lee, MD a, * a Texas Children’s Fetal Center and the Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas b Texas Children’s Hospital and the Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas c Extracorporeal Life Support Organization, University of Michigan, Ann Arbor, Michigan article info Article history: Received 6 January 2012 Received in revised form 18 June 2012 Accepted 23 July 2012 Available online 10 August 2012 Keywords: Persistent pulmonary hypertension of the newborn PPHN Extracorporeal membrane oxygenation ECMO ELSO Outcome Complications abstract Purpose: Despite improvements in the management of persistent pulmonary hypertension of the newborn (PPHN), a number of infants with inadequate gas exchange are treated with extracorporeal membrane oxygenation (ECMO). The objectives of this study were to use the Extracorporeal Life Support Organization Registry to review the outcomes of neonates with PPHN receiving ECMO, and to identify pre-ECMO variables that may be associated with increased mortality. Materials and methods: The study is a retrospective analysis of all patients with PPHN sup- ported with ECMO and reported to the Extracorporeal Life Support Organization registry from 2000 to 2010. Prematurity was defined as <37 wk gestation. Univariate analysis was per- formed using Student’s t-test or Fisher’s exact test. Variables found to be statistically significant underwent multivariate analysis by logistic regression. Kaplan-Meier survival curves were generated to analyze the relationship between duration of ECMO support and patient survival. Results: A total of 1569 neonates with PPHN received ECMO support during the study period, at an average age of 3.1 d of life and for a duration of 6.9 d. Survival among neonates with PPHN receiving ECMO support was 81%, and those receiving support for 7, 10, 14, and 21 d survived at rates of 88%, 78%, 55%, and 25%, respectively. By logistic regression, prema- turity (P < 0.01), pre-ECMO pH 7.2 (P ¼ 0.02), pre-ECMO SaO 2 65% (P ¼ 0.01), and duration of ECMO 7d(P < 0.001) were independent predictors of death in this group. An average of 2.2 complications occurred per patient, with cardiovascular, mechanical, and renal complications being the most common. Conclusions: Neonates with PPHN have high survival rates with ECMO support. Prematurity, acidosis, and profound hypoxemia are independently associated with increased mortality. Furthermore, prolonged ECMO support (>7 d) is associated with a higher risk of mortality in this cohort than in patients supported for <1 wk. ª 2012 Elsevier Inc. All rights reserved. * Corresponding author. 6701 Fannin Street, Suite 1210, Houston, TX 77030. Tel.: (832) 822-3135; fax: (832) 825-3141. E-mail address: timlee@bcm.edu (T.C. Lee). Available online at www.sciencedirect.com journal homepage: www.JournalofSurgicalResearch.com journal of surgical research 177 (2012) 263 e267 0022-4804/$ e see front matter ª 2012 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2012.07.058